DİFERANSİYE TİROİD KANSERLİ HASTALARDA TİROTROPİN SUPRESYON DÜZEYİNİN DİYASTOLİK KALP FONKSİYONLARI ÜZERİNE ETKİSİ

Yıl 2024, , 484 - 489, 21.10.2024

Ziynet Alphan Üç , Semih Çelik , Ozkan Candan

https://doi.org/10.18229/kocatepetip.1445719

Öz

AMAÇ: Bu çalışmanın amacı opere diferansiye tiroid kanserli (DTK) hastalarda tiroid-stimüle edici hormon (TSH) supresyon düzeylerine göre kardiyak yapı ve diyastolik fonksiyonlardaki değişikliklerin araştırılmasıdır.
GEREÇ VE YÖNTEM: Kesitsel olarak dizayn edilen bu araştırmaya hastanemiz endokrinoloji polikliniğinde takipli, tiroid cerrahisi sonrası bir yıldan uzun süredir tiroid hormon replasmanı ve TSH supresyon tedavisi alan 125 DTK’lı hasta dahil edildi. Çalışmamızda olgular American Thyroid Association (ATA) 2015 kılavuzu risk değerlendirmelerine uygun olarak gruplara ayrılmıştır. Buna göre hastalar birinci grup TSH seviyesi <0,1 mIU/L olanlar (n:30), ikinci grup TSH düzeyi 0,1-0,5 mIU/L arasında olanlar (n:56) ve üçüncü grup ise TSH düzeyi 0,5-2 mIU/L arasında olanlar (n:39) şeklinde üç gruba kategorize edilmiştir. İlk iki grup supresyon, 3. grup ise replasman (kontrol) grubu olarak belirlenmiştir. Tüm hastalara M-mode ve pulse-vave doku dopler ekokardiyografi yapılmıştır.
BULGULAR: Sol ventrikül diyastol sonu çapı (EDD), TSH aralığı <0,1 mIU/L olan grupta, replasman grubuna göre anlamlı olarak daha uzun bulunmuştur (45,35±3,54 ve 42,74±6,08; p=0,016). Yine erken diastolik dolumda mitral kapak velositesini gösteren E velocity grup 1 de, replasman grubuna göre anlamlı olarak daha düşük bulunmuştur (0,7(0,6-0,8) ve 0,84(0,7-0,98); p=0,010). A, E’ velositeleri ve E/A oranı gruplar arasında farklılık göstermemiştir.
SONUÇ: Diferansiye tiroid kanseri nedeniyle TSH supresyon tedavisi alan hastalarda, klinik semptom olmamasına rağmen, farklı TSH supresyon düzeylerinde, miyokard yapı ve fonksiyonlarında değişiklikler farklı olabilmektedir. Diyastolik disfonksiyonun erken saptanması açısından özellikle yüksek riskli DTK grubunda kardiyak değerlendirmelerin yapılması önemlidir. TSH supresyonu yapılan hastaların takiplerinin aksatılmaması ve supresyon seviyelerinin bireysel olarak uyarlanması gereklidir.

Anahtar Kelimeler

Diferansiye tiroid kanseri, TSH supresyon düzeyi, Diyastolik disfonksiyon.

EFFECT OF THYROTROPIN SUPPRESSION LEVEL ON DIASTOLIC HEART FUNCTIONS IN PATIENTS WITH DIFFERENTIATED THYROID CANCER

Öz

OBJECTIVE: The aim of this study was to investigate the changes in cardiac structure and diastolic functions according to thyroid-stimulating hormone (TSH) suppression treatment degree in patients with differentiated thyroid cancer (DTC).
MATERIAL AND METHODS: This cross-sectional study included 125 patients with DTC who were being followed in the endocrinology clinic of our hospital and had been receiving thyroid hormone replacement and TSH suppression therapy for more than one year following thyroid surgery. In our study, patients were divided into groups based on the American Thyroid Association (ATA) 2015 guideline risk assessments. The patients were divided into three groups: first group patients with TSH levels <0.1 mIU/L (n=30), second group those with TSH levels between 0.1-0.5 mIU/L (n=56), and third group those with TSH levels between 0.5-2 mIU/L (n=39). The first two groups were classified as suppression groups, and the third as replacement (control) group. All patients underwent M-mode and pulse-vave tissue doppler echocardiography.
RESULTS: The group 1 with TSH interval <0.1 mIU/L had significantly longer left ventricular end-diastolic diameter (EDD) than the replacement group (45.35±3.54 vs. 42.74±6.08; p=0.016). E velocity, which measures mitral valve velocity at early diastolic filling, was found to be significantly lower in group 1 than in the replacement group (0.7(0.6-0.8) and 0.84(0.7-0.98); p=0.010). The groups did not differ in terms of A, E' velocities, or E/A ratio.
CONCLUSIONS: In patients receiving TSH suppression therapy for differentiated thyroid cancer, changes in myocardial structure and function may vary depending on the level of TSH suppression, even if clinical symptoms are absent. Cardiac evaluations are critical for early detection of diastolic dysfunction, particularly in the high-risk DTK group. Follow-up of patients receiving TSH suppression should not be interrupted, and suppression levels should be adjusted individually.

Anahtar Kelimeler

Differentiated thyroid cancer, TSH suppression level, Diastolic disfunctions.

Kaynakça

• 1. Kitahara CM, Sosa JA. The changing incidence of thyroid cancer. Nat Rev Endocrinol. 2016;12(11):646-653.
• 2. Cooper DS, Specker B, Ho M, et.al. 3rd. Thyrotropin suppression and disease progression in patients with differentiated thyroid cancer: results from the National Thyroid Cancer Treatment Cooperative Registry. Thyroid. 1998;8(9):737-44.
• 3. Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016 ;26(1):1-133.
• 4. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system: From theory to practice. J Clin Endocrinol Metab. 1994; 78(5): 1026–27.
• 5. Fazio S, Palmieri EA, Lombardi G, Biondi B. Effects of thyroid hormone on the cardiovascular system. Recent Prog Horm Res. 2004;59:31-50.
• 6. Biondi B, Palmieri EA, Fazio S, et al. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients. J Clin Endocrinol Metab. 2000; 85(12):4701–5.
• 7. Wang R, Yang L, Jin S, Han X, Liu B. Thyroid stimulating hormone suppression time on cardiac function of patients with differentiated thyroid carcinoma. Cancer Cell International. 2018;18:1-6.
• 8. Hoftijzer HC, Bax JJ, Heemstra KA, et al. Short-term overt hypothyroidism induces discrete diastolic dysfunction in patients treated for differentiated thyroid carcinoma. Eur J Clin Invest. 2009;39(3):204–10.
• 9. Shargorodsky M, Serov S, Gavish D, Leibovitz E, Harpaz D, Zimlichman R. Long-term thyrotropin-suppressive therapy with levothyroxine impairs small and large artery elasticity and increases left ventricular mass in patients with thyroid carcinoma. Thyroid. 2006;16(4):381–86.
• 10. Hong K-S, Son J-W, Ryu OH, Choi M-G, Hong JY, Lee SJ. Cardiac effects of thyrotropin oversuppression with levothyroxine in young women with differentiated thyroid cancer. International Journal of Endocrinology. 2016;23:1-6.
• 11. Shapiro LE, Sievert R, Ong L, et al. Minimal cardiac effects in asymptomatic athyreotic patients chronically treated with thyrotropin-suppressive doses of L-thyroxine. J Clin Endocrinol Metab. 1997;82(8):2592–95.
• 12. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1-64.
• 13. Suh B, Shin DW, Park Y, et al. Increased cardiovascular risk in thyroid cancer patients taking levothyroxine: a nationwide cohort study in Korea. Eur J Endocrinol. 2019;180(1):11-20.
• 14. Zoltek M, Andersson TM, Hedman C, Ihre-Lundgren C, Nordenvall C. Cardiovascular Incidence in 6900 Patients with Differentiated Thyroid Cancer: a Swedish Nationwide Study. World J Surg. 2020;44(2):436-41.
• 15. Biondi B, Fazio S, Cuocolo A, et al. Impaired cardiac reserve and exercise capacity in patients receiving long-term thyrotropin suppressive therapy with levothyroxine. J Clin Endocrinol Metab. 1996;81(12):4224-28.
• 16. Biondi B, Fazio S, Carella C, et al. Cardiac effects of long term thyrotropin-suppressive therapy with levothyroxine. J Clin Endocrinol Metab. 1993;77(2):334-8.
• 17. Taillard V, Sardinoux M, Oudot C, et al. Early detection of isolated left ventricular diastolic dysfunction in high-risk differentiated thyroid carcinoma patients on TSH-suppressive therapy. Clin Endocrinol (Oxf). 2011;75(5):709–14.
• 18. Galderisi M. Diastolic dysfunction and diastolic heart failure: diagnostic, prognostic and therapeutic aspects. Cardiovasc Ultrasound. 2005;3:1-14.
• 19. Fazio S, Biondi B, Carella C, et al. Diastolic dysfunction in patients on thyroid-stimulating hormone suppressive therapy with levothyroxine: beneficial effect of beta-blockade. J Clin Endocrinol Metab. 1995;80(7):2222-26.
• 20. Mercuro G, Panzuto MG, Bina A, et al. Cardiac function, physical exercise capacity, and quality of life during long-term thyrotropin-suppressive therapy with levothyroxine: effect of individual dose tailoring. J Clin Endocrinol Metab. 2000;85(1):159-64